Cardiac arrest survivors with moderate elevated body mass index may have a better neurological outcome: a cohort study

Aim

Body mass index (BMI) may influence the quality of cardiopulmonary resuscitation and may influence prognosis after cardiac arrest. To review the direct effect of obesity on outcome after cardiac arrest, the following cohort study was conducted.

Methods

This study based on a cardiac arrest registry comprising all adult patients with cardiac arrest of non-traumatic origin and restoration of spontaneous circulation (ROSC) admitted to the department of emergency medicine of a tertiary-care facility. Data were collected between January 1992 and December 2007 according to the Utstein criteria. We assessed the association between BMI according to the WHO classification (underweight, BMI < 18.5; normal weight, 18.5-24.9; overweight, 25.0-29.9; obese ≥ 30), six-month survival and neurological recovery.

Results

Analysis was carried out on a total of 1915 adult patients (32% female). Patients had a median age of 59 years (interquartile range [IQR] 49-70) and a median BMI of 26.0 (IQR 23.9-29.1). Survival to six months was 50%. There was no significant difference in survival between the BMI groups (underweight 46%, normal weight 47%, overweight 52%, obese 51%). In a multivariate analysis neurological outcome was better in overweight patients as compared to subjects with normal BMI (odds ratio 1.35; 95% confidence interval 1.02-1.79).

Conclusion

Body mass index may have no direct influence on six-month survival after cardiac arrest, but patients with moderately elevated BMI may have a better neurological prognosis.     

Effects of garcinia cambogia (Hydroxycitric Acid) on visceral fat accumulation: a double-blind, randomized, placebo-controlled trial

Background

(-)-Hydroxycitric acid (HCA) is an active ingredient extracted from the rind of the Indian fruit Garcinia cambogia. It inhibits adenosine triphosphate citrate lyase and has been used in the treatment of obesity.

Objective

The primary end point of this study was the effects of 12 weeks of G cambogia extract administration on visceral fat accumulation. The secondary end points were body indices (including height, body weight, body mass index [BMI], waist and hip circumference, and waist-hip ratio) and laboratory values (including total cholesterol, triacylglycerol, and free fatty acid).

Methods

This study was performed according to a double-blind, randomized, placebo-controlled, parallel-group design. Subjects aged 20 to 65 years with a visceral fat area >90 cm² were enrolled. Subjects were randomly assigned to receive treatment for 12 weeks with G cambogia (containing 1000 mg of HCA per day) or placebo. At the end of the treatment period, both groups were administered placebo for 4 weeks to assess any rebound effect. Each subject underwent a computed tomography scan at the umbilical level at −2, 0, 12, and 16 weeks.

Results

Forty-four subjects were randomized at baseline, and 39 completed the study (G cambogia group, n = 18; placebo group, n = 21). At 16 weeks, the G cambogia group had significantly reduced visceral, subcutaneous, and total fat areas compared with the placebo group (all indices P<0.001). No severe adverse effect was observed at any time in the test period. There were no significant differences in BMI or body weight at week 12, but there were slight numeric decreases in body weight and BMI in men. There were no signs of a rebound effect from week 12 to week 16.

Conclusion

G cambogia reduced abdominal fat accumulation in subjects, regardless of sex, who had the visceral fat accumulation type of obesity. No rebound effect was observed. It is therefore expected that G cambogia may be useful for the prevention and reduction of accumulation of visceral fat.     

English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors

Context

In the United States, limited English proficiency has been shown to have a negative influence on effective functioning in the health care environment. Minority immigrant populations, therefore, may be especially vulnerable to poorer symptom management and quality of life (QOL) during and after cancer treatment, given their limited language skills. Breast cancer is the most prevalent cancer in Asian-American women but little is known about its adverse consequences in this population.

Objectives

We examined the extent to which English proficiency was associated with symptoms and QOL in Chinese- (n = 72) and Vietnamese-American (n = 25) breast cancer survivors in Houston, Texas.

Methods

Data were collected through face-to-face interviews. Symptoms and QOL were assessed using the Edmonton Symptom Assessment Scale and the Quality of Life Instrument-Breast Cancer Patient Version (QOL-BC), respectively.

Results

The most commonly reported severe symptoms (≥7 on a 0-10 scale) were lack of well-being (38%), fatigue (26%), pain (18%), lack of appetite (14%), anxiety (14%), and feeling depressed (14%). For the QOL-BC, the physical (mean = 6.78; standard deviation [SD] = 1.28) and spiritual subscales (mean = 6.01; SD = 2.18) had the highest and lowest mean scores, respectively. Of the whole sample, 33% reported having the ability to understand, read, speak, and write in English very well. English proficiency was significantly associated with symptom distress (coefficient = −0.257; P = 0.011) and QOL (coefficient = −0.390; P = 0.002).

Conclusion

English proficiency has a significant impact on symptom distress and QOL. These findings may help the development of services to meet the unique needs of Vietnamese- and Chinese-American breast cancer survivors.     

A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer

Objective

To compare the incidence of treatment-related complications, including lymphoedema, after two programmes of shoulder mobilisation in women with invasive breast cancer when surgical treatment included axillary lymph node dissection.

Design

Randomised controlled trial.

Setting

Two secondary care National Health Service trusts.

Participants

One hundred and sixteen women (mean age 57 years, standard deviation 13.1 years) recruited from November 2003 to March 2006 (58 intervention group, 58 control group). Seven patients (6%) did not complete the study.

Intervention

Arm exercises and shoulder movement restricted to below shoulder level for the first 7 days after surgery. Controls commenced an exercise programme that incorporated exercises above shoulder level within 48 hours.

Outcome measures

All outcomes were recorded at baseline (pre-operatively) and at 1 year. The primary outcome was incidence of lymphoedema, defined by a limb volume difference of 200 ml or more compared with the contralateral arm. This outcome was measured using volume displacement. Secondary outcome measures included volume differences between the two limbs measured by actual volume displacement difference, wound drainage volumes, range of shoulder movement (manual goniometer), grip strength (hand-held dynamometer) and health-related quality of life (Shoulder Disability Questionnaire, Functional Assessment of Cancer Therapy - Breast).

Results

All statistical tests were two-sided. Data were analysed using intention-to-treat principles. The incidence of lymphoedema (200 ml or more) increased significantly in women who had undertaken a programme of early full shoulder mobilisation. Twenty-two women (19%) developed lymphoedema (200 ml or more) in their first postoperative year. There were significantly more women with lymphoedema in the early full shoulder mobilisation group (n = 16) compared with the delayed full shoulder mobilisation group (n = 6). The relative risk of developing lymphoedema after early mobilisation was 2.7 (95% confidence interval 1.1 to 6.3; P = 0.031). Limb volume differences were significantly higher in the early mobilisation group. This was apparent in differences in limb volume displacement (P = 0.004) and percentage difference between the two limbs (P = 0.007). There were no statistically significant differences in shoulder movement, grip strength or self-evaluated outcomes between the two groups at 1 year.

Conclusion

A programme of exercise that delays full shoulder mobilisation for 1 week is recommended after axillary node dissection for invasive breast cancer.     

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients

Context

Pain is a common complaint in oncology patients, and success in its treatment requires accurate assessment. Thus, assessment tools that are practical, culturally sensitive, and psychometrically sound are needed.

Objectives

The purpose of this study was to evaluate the psychometric properties and cultural sensitivity of the Arabic Brief Pain Inventory (BPI) in a Lebanese sample of cancer patients. The BPI measures the location and severity of pain; pain relief from treatment; and the pain’s interference with life.

Methods

The BPI was translated into Arabic. Its cultural sensitivity was evaluated by a panel of experts. This instrument and a visual analogue scale for pain were administered to a convenience sample of 75 adult oncology patients receiving pain treatment.

Results

The experts’ ratings indicated that the tool was culturally sensitive. The majority of the patient sample (88%) was married, male (78.7%), older than 46 years (56%), and with at least a secondary education (84%). The mean pain intensity rating was 5.3 ± 1.7, with interference ratings of 5.3 ± 2.0 to 7.0 ± 2.5. Most patients (78.4%) reported more than 50% pain relief with treatment. Cronbach alpha coefficients were 0.82 and 0.92 for the severity and interference items, respectively. Factor analysis yielded two factors, replicating the severity and interference dimensions. Correlations between the severity and interference items ranged between 0.25 and 0.57 (P < 0.05).

Conclusion

The findings support the validity, reliability, and cultural sensitivity of the Arabic BPI in Lebanese oncology patients. This tool can be used to assess pain and improve its management in this population.     

Ability of nurses to identify depression in primary care, secondary care and nursing homes—A meta-analysis of routine clinical accuracy

Purpose

To clarify the ability of nurses and nursing assistants working in primary care, secondary care and nursing homes to identify depressed individuals using their clinical skills using meta-analysis of published studies.

Methods

Literature search, appraisal and meta-analysis. We located 22 studies reporting on the detection of depression, 4 involving primary care or community nurses; 7 involving hospital nurses and 11 from nursing homes.17 of 22 studies had specificity data.

Results

Across all 22 studies involving 7061 individuals, and a prevalence of 28.1% (95% CI = 22.6-33.9%), practice and community nurses correctly identified 26.3% (95% CI = 16.2-37.8%) of people with depression. They also correctly identified 94.8% (95% CI = 91.3-97.4%) of the non-depressed. Nurses working in hospital settings correctly identified 43.1% (95% CI = 31.9-54.8%) of people with depression and 79.6% (95% CI = 71.5-86.7%) of the non-depressed. Those working in nursing homes correctly identified 45.8% (95% CI = 38.1-53.6%) of people with depression and 80.0% (95% CI = 68.6-88.7%) of the non-depressed.

Conclusions

Nurses have considerable difficulty accurately identifying depression but are probably at least as accurate as medical staff.     

Differences in sleep disturbance and fatigue between patients with breast and prostate cancer at the initiation of radiation therapy

Context

Little is known about the occurrence and severity of sleep disturbance and fatigue between patients with common cancer diagnoses.

Objectives

Study purposes were to evaluate for differences in the occurrence rates of sleep disturbances and fatigue; evaluate for differences in the severity of sleep disturbance using both subjective and objective measures; and evaluate for differences in the severity of self-reported fatigue in patients with breast and prostate cancer at the initiation of radiation therapy (RT).

Methods

Patients with breast (n = 78) and prostate (n = 82) cancer were evaluated before the initiation of RT using the Pittsburgh Sleep Quality Index, General Sleep Disturbance Scale, Lee Fatigue Scale, and wrist actigraphy. Differences in sleep disturbance and fatigue between groups were evaluated using independent sample t-tests and Chi-square analyses.

Results

Occurrence rates for sleep disturbance (P < 0.0001) and fatigue (P = 0.03) were significantly higher in patients with breast compared with prostate cancer. Patients with breast cancer self-reported significantly higher levels of sleep disturbance (P = 0.008) and fatigue (P = 0.005) than patients with prostate cancer. However, using actigraphy, patients with prostate cancer had poorer sleep efficiency (P = 0.02) than patients with breast cancer.

Conclusion

Based on self-report, patients with breast cancer experience sleep disturbance more frequently and with greater severity than patients with prostate cancer. Objective measures of sleep disturbance suggest that prostate cancer patients have more severe sleep disturbance than breast cancer patients. All the patients experienced poor sleep quality and fatigue, which suggests that oncology patients need to be assessed for these symptoms.     

Protein carbonyls as a biomarker of foetal-neonatal hypoxic stress

Objectives:

Investigation of the effect of hypoxic conditions during labour on the protein oxidative modifications and changes in plasma antioxidative capacity of newborns.

Design and methods:

Oxidative damage to proteins was determined by high-performance liquid chromatography. Antioxidative status was monitored by Trolox equivalent antioxidant capacity method. In our study, 11 hypoxic and 19 normoxic newborns were involved.

Results:

In hypoxic newborns, we have found a significant increase in protein carbonyl levels (3.55 ± 0.86 versus 3.24 ± 0.69 mol carbonyls/mol proteins, p = 0.045) and plasma antioxidant capacity (1.76 ± 0.056 versus 1.68 ± 0.097 mmol Trolox/L, p = 0.004) when compared to normoxic children. Bilirubin levels were unchanged (p = 0.87).

Conclusion:

Our results show elevated levels of carbonyls in hypoxic neonates compared to normoxic children. The oxidative damage to proteins is not sufficiently prevented by increased antioxidant capacity detected in plasma of hypoxic newborns.     

The Hyperemesis Impact of Symptoms Questionnaire: Development and validation of a clinical tool

Background

The Hyperemesis Impact of Symptoms Questionnaire is a clinical tool designed to assess holistically the impact of the physical and psychosocial symptoms of hyperemesis gravidarum (HG) on individuals. Its purpose is to aid planning and implementation of tailored care for women with HG. To our knowledge no similar tool exists.

Objective

To assess the validity and reliability of the HIS questionnaire.

Design

As no similar tool exists, we compared the HIS with three tools that reflect its key areas: physical impact (Pregnancy Unique Quantification of Emesis - PUQE score and markers of severity of HG), psychological impact (Hospital Anxiety and Depression Score - HADS) and social impact (SF12 quality of life score).

Setting

A large regional referral, women and children's hospital in the North West of England.

Participants

The HIS was evaluated on 50 women admitted to hospital with HG and 50 women recruited from ante-natal clinic without severe nausea and vomiting of pregnancy and with an uncomplicated pregnancy.

Results

Good criterion validity was demonstrated by strong significant correlations with all three scores (PUQE, r = 0.75, p < 0.001, HADS, depression r = 0.76, p < 0.001, and SF12, mental component r = −0.65, p < 0.001). The HIS showed good internal consistency, Cronbach alpha 0.87, split half 0.80.

Conclusions

There is evidence for the validity and reliability of the HIS to assess the impact of the physical and psychosocial symptoms of HG. Further research is currently underway to establish the clinical utility of the HIS questionnaire in the care of women hospitalised with HG.     

“The Body Gives Way, Things Happen”: Older women describe breast cancer with a non-supportive intimate partner

Purpose

Many women identify their intimate partner as important source of support during cancer diagnosis and recovery, but little is known about how women deal with breast cancer while in a relationship self-described as difficult. The purpose of this article is to describe the aging-related experiences of older women who were diagnosed with breast cancer while in a non-supportive, difficult intimate relationship.

Method

Semi-structured qualitative interviews were conducted with a convenience sample of 16 women aged 55-84 years (mean 68.1 years) in community settings in the mid-Atlantic United States. Data were analyzed using hermeneutic phenomenological analysis.

Results

Participants self-identified as being in a difficult intimate relationship (relationship length range: 1 year- 60 years, mean 35.6 years). Reasons for relationship difficulty ranged from intimate partner abuse to terminal illness. The findings included the themes: “At my Age”: participants reflect on aging and breast cancer; breast cancer, sexuality, and aging; and silence.

Conclusions

Issues related to aging such as changes in sexual relationships, comorbidities, and partner illness complicated the women’s breast cancer experience. Despite relationship difficulties, these women coped effectively with breast cancer in various ways. Study findings will increase awareness about the unique, complex needs of older women facing breast cancer with non-supportive intimate partners. Nurses should assess older breast cancer patients keeping in mind physical functioning, comorbidities, social support network, and quality of intimate partner support.     

Sources of stress and psychological morbidity among undergraduate physiotherapy students

Objectives

Professional education can be a stressful experience for some individuals, and may impact negatively on emotional well-being and academic performance. Psychological morbidity and associated sources of stress have not been investigated extensively in physiotherapy students. This study explored sources of stress, psychological morbidity and possible associations between these variables in undergraduate physiotherapy students.

Design

A questionnaire-based survey. The Undergraduate Sources of Stress Questionnaire was used to identify sources of stress, and the General Health Questionnaire-12 (GHQ-12) was used to rate the prevalence of psychological morbidity, using a conservative GHQ threshold of 3 to 4 to determine probable ‘cases’. Uni- and multivariate tests of correlation were used to analyse the data.

Setting

An Irish educational institution.

Participants

One hundred and twenty-five physiotherapy undergraduate students.

Results

More than one-quarter of all students (27%) scored above the GHQ threshold, indicating probable psychological morbidity. This is higher than the level of psychological morbidity reported by the general population. Regression analysis showed that academic (β = 0.31, P < 0.001) and personal (β = 0.50, P < 0.001) sources of stress subscales were significant coefficients, explaining 48% of the variance in psychological morbidity after controlling for part-time employment and hours spent studying. Individual significant items from these subscales were stressful events (β = 0.24, P = 0.004), mood (β = 0.43, P ≤ 0.001) and overall level of stress (β = 0.35, P ≤ 0.001).

Conclusions

The results highlighted the emotional vulnerability of a significant proportion of physiotherapy students, with academic and personal issues being the greatest concern. While personal causes of stress such as stressful events and mood are more difficult to control, manipulation of curricular factors may have positive effects on academic sources of stress.     

Pain reduction of acupoint electrical stimulation for patients with spinal surgery: a placebo-controlled study

Background

Acupoint electrical stimulation (AES) is commonly used for pain management. However, its true or placebo effect to achieve pain relief needs to be verified.

Objective

This study aimed to examine the true effect of AES to reduce postoperative pain in patients with spinal surgery receiving patient-controlled analgesia (PCA).

Method

A placebo- and sham-controlled study was conducted. Participants were randomly assigned to intervention with AES at true acupoints (the AES group, n = 30), AES at sham acupoints (the sham group, n = 30), or no intervention with AES (the control group, n = 30). Outcomes were assessed according to the amount of pain experienced and analgesics used.

Results

There were significant differences among the three groups in pain relief across time, and the occurrence of PCA button pushed and amount of analgesics used. The beneficial effects of AES were discernible when compared to the sham and the control.

Conclusions

AES at the true acupoints effectively reduced postoperative pain and analgesic usage. AES has now been implemented into healthcare and it is recommended that nurses be provided with the opportunity to earn their AES skills. More studies evaluating the effects of AES over a longer period and on pain after different surgical procedures are suggested.     

Association between PON1 5′-regulatory region polymorphisms, PON1 activity and ischemic stroke

Objectives

Paraoxonase I (PON1) was known as a risk factor for cerebrovascular diseases. This study assessed the association of single nucleotide polymorphisms (SNPs) in the PON1 5′-regulatory region with ischemic stroke and serum PON1 activity.

Design and methods

Study subjects consisted of 418 healthy controls and 86 ischemic stroke patients with small vessel occlusion. SNPs were identified by DNA sequencing and a primer extension-based method.

Results

Among 10 identified SNPs, only −1434GG genotype was observed with a lower frequency in patients on borderline statistical significance (OR(95% CI), 0.297(0.083-1.060), p = 0.0615). However, haplotype analysis in a dominant model revealed that ht2 was observed with a significantly lower frequency in patients (OR(95% CI), 0.390(0.153-0.991), p = 0.0477). Both C(−1434)G mutation and ht2 distribution were associated with serum PON1 activity.

Conclusion

Our results suggest that haplotypes observed in the PON1 5′-regulatory region should be considered as risk factors for ischemic stroke.     

Implementation of newborn screening for Krabbe disease: Population study and cutoff determination

Objective

The aim of this study was to develop a newborn screening algorithm for Krabbe disease.

Design and methods

We measured the galactocerebrosidase activity of 139,074 anonymous newborns, 56 known carriers, and 16 Krabbe patients using a tandem mass spectrometry method. The activities were converted to percentages of daily mean activity (%DMA), and the results from diseased and normal populations were used to establish cutoffs.

Results

The absolute activities for the newborns ranged from 0.17 to 355 μmol/L h (N = 139,074) and activities for Krabbe-positive controls ranged from 0.08 to 0.48 μmol/L h (N = 16, n = 91 measurements) while activities for carriers ranged from 0.28 to 2.71 μmol/L h (N = 56, n = 72 measurements). Cutoffs were set based on results from Krabbe-positive and carrier controls and the newborn population distribution.

Conclusions

The algorithm and cutoffs we propose provided 100% detection of all positive controls with 60/100,000 screen positive results predicted. In the course of this study, one anonymous newborn was predicted to have Krabbe disease based on enzyme activity and subsequent DNA analysis.     

Thyroid disorders in pregnancy: frequency and association with selected diseases and obstetrical complications in Tunisian women

Objective

To determine the prevalence of thyroid disorders (TDs) and identify groups at risk for TDs in Tunisian pregnant women.

Methods

Thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase antibodies (TPO-Ab) were determined in 1519 pregnant women. Thyroid disorder was defined as hyperthyroidism (TSH ≤ 0.10 mIU/L) or hypothyroidism (TSH > 4.5 mIU/L), and/or positive TPO-Ab (> 12 IU/L).

Results

TDs were observed in 147 women (9.7%). The prevalence was 6.5%, 3.2% and 1.3% for positive anti-TPO, hypothyroidism and hyperthyroidism, respectively. According to a trimester of gestation (first, second, and third, respectively), the prevalence decreases for positive TPO-Ab (7.7%, 7.5% and 4.7%) and for hyperthyroidism (2.7%, 0.7% and 0.5%), but increases for hypothyroidism (2.2%, 3.3% and 3.7%). TDs were more frequent in women with non-thyroid autoimmune disease [25% vs 9.6%; odds ratio (OR), 95% confidence interval (95% CI), 3.16 (1.01-11.8); p = 0.05]. Women with positive TPO-Ab showed higher prevalence of non-thyroid autoimmune disease [25% vs 6.4%; OR (95% CI), 4.90 (1.31-18.4); p = 0.04] and a trend toward increase of past gestational hypertension (p = 0.09), late abortion (p = 0.09), and fetal death (p = 0.09). Hypothyroidism was more frequent in women with non-thyroid autoimmune disease and those with past pregnancy loss.

Conclusions

TDs are common in Tunisian pregnant women and are associated with autoimmune diseases and poor gestational outcomes. These data support the benefit of thyroid testing in pregnant women, especially those with these conditions.     

The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial

Introduction

Women's traditional way of breastfeeding has altered in Jordan with rates declining in recent years.

Objective

The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months, improve the women's level of breastfeeding knowledge, and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses.

Methods

A randomized controlled trial was conducted in 90 primiparous women who had given birth to a healthy, full term, singleton baby at two hospitals in the southern region of Jordan. Women were randomly allocated to either the intervention group (n = 45), in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum, or the control group (n = 45), in which they received routine postnatal care. The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women's level of breastfeeding knowledge at six months postpartum.

Results

The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores. This was statistically significant for the intervention group (p < 0.001) but was not significant for the control (p = 0.23). The proportion of women fully breastfeeding their babies at 6 months was not found to be statistically significantly different between the intervention group (39%) and the control group (27%), percentage difference = 12% (95% confidence interval [−9% to 30%], Chi squared: χ² = 3.54, p > 0.05).

Conclusions

Although the postnatal education and support program improved breastfeeding knowledge among women in the study, this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months.     

Early risk stratification of patients with major trauma requiring massive blood transfusion

Background

There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion (MT) protocol.

Objective

To risk stratify patients with major trauma and to predict need for MT.

Designs

Retrospective analysis of an administrative trauma database of major trauma patients.

A regional trauma Centre

A regional trauma centres in Hong Kong.

Patients

Patients with Injury Severity Score ≥9 and age ≥12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24 h were excluded.

Main outcome measures

Delivery of ≥10 units of packed red blood cells (RBC) within 24 h.

Results

Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥10 units RBC within 24 h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥120/min; systolic blood pressure ≤90 mmHg; Glasgow coma scale ≤8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5 mmol/L; hemoglobin ≤7 g/dL; and hemoglobin 7.1-10 g/dL. At a cut off of ≥6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889.

Conclusion

A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set.